Post kala azar dermal leishmaniasis: skin lesion

This is a medium power view of a section of skin from a patient with PKDL. There is an inflammatory infiltrate with epithelioid cells which are not organized into granulomas. H&E stain. Lesions seen in PKDL do not arise from direct inoculation by an infected sand fly but from blood-borne parasites as a consequence of visceral leishmaniasis (VL). The early cutaneous lesions surround a dermal blood vessel, and then enlarge and spread through the dermis.